Search PubMed⌕ Search

Biomedical subjects

F R Lewis

Publications and source records attributed to F R Lewis.

At least 37 records · Page 2Linked to original sources
PubMed1992

Can adult trauma surgeons care for injured children?

Large urban trauma centers care for injured children as well as adults in many areas of the country, but the quality of care in these hospitals has not been evaluated versus that available at pediatric trauma centers. The recent validation of TRISS methodology in pediatric populations allowed us to evaluate the quality of pediatric trauma care being provided in a level I trauma center treating injured patients of all ages. We reviewed the records of 353 injured children (aged 0-17 years) who were admitted to our trauma center over a 30-month period for the following data: demographics, mechanism of injury, initial physiologic status (RTS), surgical procedures required, need for intensive care, nature and severity of the injuries (ISS), and outcome. TRISS analysis allowed us to compare our population with the Major Trauma Outcome Study. Only two of the 21 total deaths (overall mortality, 6%) were unexpected, and there were seven unexpected survivors. One hundred twenty-one patients underwent emergency surgical procedures and 63 required admission to the intensive care unit. The Z scores ranged from +0.32 for the children aged less than 2 years to +3.98 for the older age group (14-17 years). We conclude that the quality of care for pediatric trauma patients admitted to trauma centers that care for patients of all ages compares favorably with national standards. In most areas of the country, improvements in pediatric trauma care will likely come from addressing the special needs of injured children in general trauma centers rather than from developing separate pediatric facilities.

Adolescent↗
PubMed1991

Relationship between skin fluorescence and blood flow in normal and in chronically ischemic subjects dosed with fluorescein.

To elucidate parameters diagnostic of chronic ischemia, the fluorescence of skin on the foot, leg, arm, and forehead of six chronically ischemic patients and six normal subjects injected with fluorescein was measured serially using a surface-measurement fluorometer (dermofluorometer). Simultaneously collected plasma samples were assayed spectrofluorometrically for unmetabolized fluorescein. The time courses of plasma fluorescein content and dermofluorometer readings were jointly analyzed by combining a standard pharmacokinetic model, a model predicting skin site from plasma concentrations of fluorescein, and a model predicting the dermofluorometer response to those skin concentrations. Fluorescein plasma clearance (0.22 +/- 0.06 versus 0.46 +/- 0.20 L/h/kg) in ischemic patients was only half, and half-life was double (2.4 +/- 1.0 versus 1.3 +/- 0.3 h) those in normal subjects, with volume of distribution (Vdss = 0.46 L/kg) being similar. Despite the ischemia diagnosis for all patients involving claudication of the lower extremities, patients could be distinguished statistically from normal subjects on the basis of fluorescence readings taken on the arm, but not those using the foot or leg. The rate constant describing flux of fluorescein from the arm skin site in patients was only half that in normal subjects, and the peak reading on the arm occurred at 42 +/- 14 min after fluorescein injection in patients, but at only 15 +/- 6 min in normal subjects. Lack of discrimination between subject groups via leg and foot readings may be due to several physiologic and/or experimental factors, including the need to take skin surface readings much earlier than previously recognized.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Iodinated contrast media effects on extravascular lung water, central blood volume, and cardiac output in humans.

Intravascular contrast media produce pulmonary edema in one rat model, but not in dogs or pigs. In humans, pulmonary edema after contrast media is rarely diagnosed, but subclinical edema could be more frequent than believed previously. Therefore, the authors prospectively studied the effects of diatrizoate (n = 5) and ioxaglate (n = 5) on extravascular lung water, central blood volume, and cardiac output in ten patients undergoing routine radiographic procedures. Variables were measured by thermal-dye dilution before and every 5 minutes after completion of the procedure for four repetitions. Extravascular lung water and central blood volume did not change significantly, indicating that pulmonary edema or pulmonary congestion did not occur. Cardiac output was elevated by 10.6% immediately after the procedure, but returned to baseline during the 10 following minutes. The authors conclude from this preliminary study in a small number of patients that intraarterial contrast media (less than 1.5 g/kg body weight of iodine) did not produce pulmonary edema or pulmonary congestion, even at a subclinical level.

Blood Volume↗
PubMed1990

Independence of intrapericardial right and left ventricular performance in septic pulmonary hypertension.

To study the effect of septic pulmonary hypertension on right/left ventricular intrapericardial interactions thirteen trauma patients, seven septic and six non-septic controls, were compared. Ventricular volumes were derived from first-pass or gated equilibrium radionuclide angiocardiography, and related to body surface area. Systemic and pulmonary pressures were measured invasively. Pulmonary arterial pressure was significantly increased in the sepsis group. Although right ventricular end-diastolic volumes were higher in sepsis, left ventricular end-diastolic volumes were not decreased. In terms of intrapericardial right/left ventricular interactions these results indicate that the right and left ventricles operate independently in septic pulmonary hypertension.

Adult↗
PubMed1989

Post-traumatic changes in, and effect of colloid osmotic pressure on the distribution of body water.

The aim of this study was to define the post-traumatic changes in body fluid compartments and to evaluate the effect of plasma colloid osmotic pressure (COP) on the partitioning of body fluid between these compartments. Forty-two measurements of plasma volume (green dye), extracellular volume (bromine), and total body water (deuterium) were done in ten traumatized patients (mean Injury Severity Score, ISS, = 34) and 23 similar control studies were done in eight healthy volunteers who were in stable fluid balance. Interstitial volume, intracellular volume, and blood volume were calculated from measured fluid spaces and hematocrit; COP was directly measured. Studies in volunteers on consecutive days indicated good reproducibility, with coefficients of variation equal to 3.5% for COP, 6.3% for plasma volume, 4.5% for extracellular volume, and 4.9% for total body water. COP values extended over the entire range seen clinically, from 10 to 30 mmHg. Interstitial volume was increased by 55% in patients, but intracellular volume was decreased by 10%. We conclude (1) that posttraumatic peripheral edema resulting from hemodilution is located in the interstitial compartment, with no intracellular space expansion; and (2) that interstitial volume, but not intracellular volume, is closely related to plasma COP.

Blood Proteins↗
PubMed1989

Appendicitis: continuing diagnostic challenge.

Recognition of appendicitis depends on an understanding of the underlying pathophysiology and anatomy that shape the clinical presentation. Knowledge of the clinical symptoms and signs that distinguish between appendicitis and competing diagnoses enables the clinician to differentiate appendicitis from other pathologies. Variations in anatomy, pathophysiology, symptoms, and signs are described for adult men, ovulating women, pregnant women, children, the elderly, and immunocompromised patients.

Adolescent↗
PubMed1987

Regional trauma system design: critical concepts.

Regional trauma system implementation is proceeding in a number of areas of the United States in response to a demonstrated need for improved trauma care to prevent unnecessary death. The critical questions underlying the design of such systems and the current state of knowledge and opinion regarding each of them have been defined and these provide a framework for system planning. Additional data are badly needed in several areas to provide a more rational basis for system configuration. It is hoped that systems currently being implemented will include appropriate data elements in their trauma registries to answer the remaining questions in succeeding years.

Health Facility Planning↗
PubMed1987

The role of pulmonary lymphatics in the clearance of hydrostatic pulmonary edema.

Pulmonary lymphatics are believed to play a major role in preventing the formation of pulmonary edema, but their role in clearance of established edema has not been defined. To measure the lymphatic contribution to the clearance of acute hydrostatic pulmonary edema, a lung lymph fistula was established in 16 anesthetized sheep. Pulmonary edema was induced by a rapid volume infusion of Ringer's lactate (six animals) or homologous plasma (six animals). Four control animals received no fluid. Simultaneous measurements of lymph flow and extravascular lung water (EVLW) were made. Data were analyzed for the resolution phase of pulmonary edema. The contribution of the pulmonary lymphatics to resolution was expressed as a percentage of total lung water resolved. Resolution rates for crystalloid and plasma infusion groups were 3.8 +/- 2.4 cc/kg/hr and 2.7 +/- 1.0 cc/kg/hr, respectively. There was no statistically significant difference between the groups in terms of EVLW increases or resolution rates. Net measured pulmonary lymph flow during the resolution phase of pulmonary edema was 0.33 +/- 0.18 cc/kg/hr and 0.39 +/- 0.20 and accounted for only 8.8 and 14.6% of resolved pulmonary edema in these respective groups. These data suggest the pulmonary lymphatic drainage plays a very minor role in the clearance of acute hydrostatic edema. The lungs appear to be capable of resolving as much as 40% per hour of increased extravascular lung water produced under these circumstances.

Animals↗
PubMed1987

Acute appendicitis: high-resolution real-time US findings.

High-resolution, real-time ultrasonography (US) with graded compression was used to evaluate 90 patients with clinically suspected acute appendicitis. US visualization of a noncompressible appendix was the primary criterion for a diagnosis of acute appendicitis. The overall sensitivity was 89%, the specificity was 95%, and the accuracy was 93%. When the results in women were analyzed separately (n = 49), the overall accuracy was 96%. Several important limitations of US scanning were encountered. There were three false-positive examinations in patients with a sonographically visible appendix whose symptoms spontaneously resolved. Another patient had a normal compressible appendix with a thin (2-mm), symmetric wall surrounded by ascites. There were three nondiagnostic studies (3%) due to inability to compress the cecum and right lower quadrant adequately because of exquisite tenderness (two patients) or massive ascites (one patient). When interpreted in light of the clinical examination, sonography should significantly reduce the rate of false-negative appendectomies, particularly in women.

Acute Disease↗
PubMed1986

Necrotizing amebic colitis: a frequently fatal complication.

Acute necrotizing amebic colitis is an uncommon but life threatening development with a high mortality rate, even when properly diagnosed and treated. We report six cases of acute necrotizing amebic colitis, none of which were diagnosed preoperatively. At operation, five of the six patients had friable, necrotic, and gangrenous colon. A right hemicolectomy with ileostomy was performed in two patients and a subtotal colectomy with ileostomy was performed in four patients. Five of the six patients died within 4 weeks of operation. The sole survivor was the patient who had received metronidazole preoperatively. Only after histologic examination of the surgical specimen was the diagnosis made in all cases. If the diagnosis can be made preoperatively and antiamebic therapy instituted, surgical resection may decrease the high mortality rate of this disease.

Adult↗
PubMed1986

Prehospital intravenous fluid therapy: physiologic computer modelling.

A computer model incorporating known behavior of the cardiovascular system and intravascular:interstitial fluid exchange was designed which allowed bleeding rate, IV infusion rate, and prehospital care times to be independently specified. All possible circumstances were examined. The model shows that IV's are potentially of benefit only when all of the following occur: 1) the bleeding rate is initially 25-100 ml/min, 2) the prehospital time exceeds 30 minutes, and 3) the IV infusion rate is approximately equal to the bleeding rate. IV infusions therefore appear of little benefit in the usual urban environment and have a sharply limited role overall. The possibility of pulmonary edema from fluid overload in nonhypovolemic patients, and reluctance of field personnel to infuse fluid at the rates necessary to produce benefit raise further questions about realistic benefit of IV's in all but the most rural systems.

Bleeding Time↗
PubMed1984

Crystalloid resuscitation of patients with pulmonary contusion.

One hundred nine patients with the diagnosis of pulmonary contusion were studied retrospectively. Thirteen deaths were respiratory related (12 percent of patients). All of the patients were quickly resuscitated with crystalloid solutions as necessary to restore perfusion to normal. Twenty-eight of the most severely injured patients, all of whom were intubated and ventilated and in whom serial PaO2 and total protein determinations were available, were examined for the relationship between crystalloid induced hemodilution as measured by the plasma colloid oncotic pressure and oxygenation as measured by the PaO2/FiO2 ratio. When survivors and nonsurvivors were analyzed by group, both individually and collectively, no correlation was found between oxygenation and oncotic pressure. Survivors and nonsurvivors exhibited similar post-traumatic courses in the PaO2/FiO2 ratios with differences not becoming significant until the eleventh day after injury. We conclude that contusion is not a progressive lesion unless pneumonia supervenes and that pulmonary dysfunction after contusion is unrelated to hemodilution.

Adult↗
PubMed1984

The prehospital use of external counterpressure: does MAST make a difference?

Military anti-shock trousers (MAST) have achieved widespread civilian usage because of reported effectiveness in treating hypovolemic shock. The literature, however, consists of either case reports or series in which no controls were evaluated. No published reports exist which compare similar groups of patients treated with and without MAST in the pre-hospital setting. We reviewed the paramedic and emergency department records of 226 patients sustaining moderate to severe trauma who were transported to San Francisco General Hospital by paramedics over a 15 month period. MAST usage during this period was approximately random as a result of logistical and training constraints. For analysis, patients were divided into two groups: those in whom MAST was applied and inflated during transport and those in whom it was not used. Paramedic interventions other than MAST were similar in both groups. Trauma Scores (TS), and blood pressure index (greater than 90 = 4, 70-89 = 3, 50-69 = 2, 0-49 = 1, no pulse = 0), were calculated for initial field observations and initial emergency room evaluation after hospital arrival. Patients with isolated head injury were excluded. The average change in TS and BP index (E.R.--field value) was calculated for MAST and non-MAST groups of patients. Mortality and total field times were also evaluated. Average TS and BP index increased slightly in both groups. Use of MAST produced no significant improvement in trauma score, BP index, or mortality over non-MAST patients. There was no demonstrable field benefit of MAST in fully arrested patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗